Bowel Wall Thickening——CT Findings and Diagnostic Values_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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陈光文 , 宋彬 , 吴苾

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Keywords：

肠壁增厚; 计算机断层扫描

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肠道是人体容易发生疾病的部位之一，肠外局部或全身性疾病也易累及肠道。无论肠道原发疾病还是肠外疾病累及肠道，肠壁增厚都是一种常见而重要的病理改变。钡餐、钡灌肠和纤维内镜是常用的检查手段，但它们只能显示肠腔内及黏膜面的情况；灰阶超声和多普勒超声可发现肠壁及肠外异常，但敏感性和准确率低，且受操作者经验影响较大。随着影像检查技术的不断进步，CT用于肠道疾病的诊断已日益普遍，多层螺旋CT快速薄层扫描和强大的图像后处理能力使其成为显示肠壁及相关肠外病变的主要手段［1］。虽然很多疾病可造成肠壁增厚，但正确认识肠壁增厚的CT表现特征，包括部位、范围、程度、密度、强化方式和相关肠外异常征象有助于疾病的诊断和鉴别诊断［2，3］。现通过复习肠壁增厚的相关文献，介绍肠壁增厚的基本CT征象，归纳引起肠壁增厚的常见疾病及其表现，并提出CT在诊断肠壁增厚中存在的问题……

Citation： 陈光文,宋彬,吴苾. Bowel Wall Thickening——CT Findings and Diagnostic Values. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(12): 943-949. doi: Copy

1.	Hong SS, Kim AY, Byun JH, et al. MDCT of small-bowel disease: value of 3D imaging [J]. AJR Am J Roentgenol, 2006; 187(5)∶1212.
2.	Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation [J]. AJR Am J Roentgenol, 2001; 176(5)∶1105.
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13.	Herts BR, Megibow AJ, Birnbaum BA, et al. High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT [J]. Radiology, 1992; 185(3)∶777.
14.	Furukawa A, Saotome T, Yamasaki M, et al. Cross-sectional imaging in Crohn disease [J]. Radiographics, 2004; 24(3)∶689.
15.	Prassopoulos P, Papanikolaou N, Grammatikakis J, et al. MR enteroclysis imaging of Crohn disease [J]. Radiographics, 2001; 21∶S161.
16.	Jamieson DH, Shipman PJ, Israel DM, et al. Comparison of multidetector CT and barium studies of the small bowel: inflammatory bowel disease in children [J]. AJR Am J Roentgenol, 2003; 180(5)∶1211.
17.	Bodily KD, Fletcher JG, Solem CA, et al. Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography-correlation with endoscopic and histologic findings of inflammation [J]. Radiology, 2006; 238(2)∶505.
18.	Madureira AJ. The comb sign [J]. Radiology, 2004; 230(3)∶783.
19.	Engin G, Acuna B, Acuna G, et al. Imaging of extrapulmonary tuberculosis [J]. Radiographics, 2000; 20(2)∶471.
20.	Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? [J]. Radiographics, 2001; 21(6)∶1463.
21.	Lee HJ, Im JG, Goo JM, et al. Peripheral T-cell lymphoma: spectrum of imaging findings with clinical and pathologic features [J]. Radiographics, 2003; 23(1)∶7.
22.	Levy AD, Remotti HE, Thompson WM. et al. Gastrointestinal stromal tumors: radiologic features with pathologic correlation [J]. Radiographics, 2003; 23(2)∶283.
23.	Burkill GJ, Badran M, Al-Muderis O, et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread [J]. Radiology, 2003; 226(2)∶527.
24.	Boudiaf M, Soyer P, Terem C, et al. CT evaluation of small bowel obstruction [J]. Radiographics, 2001; 21(3)∶613.
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27.	宋彬, 吴苾, 徐隽. 腹腔内疝的CT表现 [J]. 中国普外基础与临床杂志, 2006; 13(3)∶ 347.
28.	del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction [J]. Radiographics, 1999; 19(2)∶299.
29.	Bluemke DA, Fishman EK, Kuhlman JE, et al. Complications of radiation therapy: CT evaluation [J]. Radiographics, 1991; 11(4)∶581.
30.	Levine DS, Navarro OM, Chaudry G, et al. Imaging the complications of bone marrow transplantation in children [J]. Radiographics, 2007; 27(2)∶307.
31.	Kalantari BN, Mortelé KJ, Cantisani V, et al. CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults [J]. AJR Am J Roentgenol, 2003; 181(6)∶1621.
32.	宋彬, 徐隽，罗小华, 等. 螺旋CT 检查在诊断狼疮性缺血性肠病中的价值 [J]. 中国普外基础与临床杂志, 2004; 11（4）∶359.
33.	Brody JM, Leighton DB, Murphy BL, et al. CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis [J]. Radiographics, 2000; 20(6)∶1525.
34.	Guingrich JA, Kuhlman JE. Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications [J]. AJR Am J Roentgenol, 1999; 172(4)∶919.

1. Hong SS, Kim AY, Byun JH, et al. MDCT of small-bowel disease: value of 3D imaging [J]. AJR Am J Roentgenol, 2006; 187(5)∶1212.
2. Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation [J]. AJR Am J Roentgenol, 2001; 176(5)∶1105.
3. d’Almeida M, Jose J, Oneto J, et al. Bowel wall thickening in children: CT findings [J]. Radiographics, 2008; 28(3)∶727.
4. Smith C, Kubicka RA, Thomas CR Jr. Non-Hodgkin lymphoma of the gastrointestinal tract [J]. Radiographics, 1992; 12(5)∶887.
5. Ahualli J. The target sign: bowel wall [J]. Radiology, 2005; 234(2)∶549.
6. Ahualli J. The fat halo sign [J]. Radiology, 2007; 242(3)∶945.
7. Harisinghani MG, Wittenberg J, Lee W， et al. Bowel wall fat halo sign in patients without intestinal disease[J]. AJR Am J Roentgenol, 2003; 181(3)∶781.
8. Macari M, Chandarana H, Balthazar E, et al. Intestinal ischemia versus intramural hemorrhage: CT evaluation [J]. AJR Am J Roentgenol, 2003; 180(1)∶177.
9. Kernagis LY, Levine MS, Jacobs JE. Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel [J]. AJR Am J Roentgenol, 2003; 180(3)∶733.
10. Chou CK, Wu RH, Mak CW. Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain [J]. AJR Am J Roentgenol, 2006; 186(2)∶491.
11. Wittenberg J, Harisinghani MG, Jhaveri K, et al. Algorithmic approach to CT diagnosis of the abnormal bowel wall [J]. Radiographics, 2002; 22(5)∶1093.
12. Karahan OI, Dodd GD 3rd, Chintapalli KN, et al. Gastrointestinal wall thickening in patients with cirrhosis: frequency and patterns at contrast-enhanced CT [J]. Radiology, 2000; 215(1)∶103.
13. Herts BR, Megibow AJ, Birnbaum BA, et al. High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT [J]. Radiology, 1992; 185(3)∶777.
14. Furukawa A, Saotome T, Yamasaki M, et al. Cross-sectional imaging in Crohn disease [J]. Radiographics, 2004; 24(3)∶689.
15. Prassopoulos P, Papanikolaou N, Grammatikakis J, et al. MR enteroclysis imaging of Crohn disease [J]. Radiographics, 2001; 21∶S161.
16. Jamieson DH, Shipman PJ, Israel DM, et al. Comparison of multidetector CT and barium studies of the small bowel: inflammatory bowel disease in children [J]. AJR Am J Roentgenol, 2003; 180(5)∶1211.
17. Bodily KD, Fletcher JG, Solem CA, et al. Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography-correlation with endoscopic and histologic findings of inflammation [J]. Radiology, 2006; 238(2)∶505.
18. Madureira AJ. The comb sign [J]. Radiology, 2004; 230(3)∶783.
19. Engin G, Acuna B, Acuna G, et al. Imaging of extrapulmonary tuberculosis [J]. Radiographics, 2000; 20(2)∶471.
20. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? [J]. Radiographics, 2001; 21(6)∶1463.
21. Lee HJ, Im JG, Goo JM, et al. Peripheral T-cell lymphoma: spectrum of imaging findings with clinical and pathologic features [J]. Radiographics, 2003; 23(1)∶7.
22. Levy AD, Remotti HE, Thompson WM. et al. Gastrointestinal stromal tumors: radiologic features with pathologic correlation [J]. Radiographics, 2003; 23(2)∶283.
23. Burkill GJ, Badran M, Al-Muderis O, et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread [J]. Radiology, 2003; 226(2)∶527.
24. Boudiaf M, Soyer P, Terem C, et al. CT evaluation of small bowel obstruction [J]. Radiographics, 2001; 21(3)∶613.
25. Khurana B, Ledbetter S, McTavish J, et al. Bowel obstruction revealed by multidetector CT [J]. AJR Am J Roentgenol, 2002; 178(5)∶1139.
26. Aguirre DA, Santosa AC, Casola G, et al. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT [J]. Radiographics, 2005; 25(6)∶1501.
27. 宋彬, 吴苾, 徐隽. 腹腔内疝的CT表现 [J]. 中国普外基础与临床杂志, 2006; 13(3)∶ 347.
28. del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction [J]. Radiographics, 1999; 19(2)∶299.
29. Bluemke DA, Fishman EK, Kuhlman JE, et al. Complications of radiation therapy: CT evaluation [J]. Radiographics, 1991; 11(4)∶581.
30. Levine DS, Navarro OM, Chaudry G, et al. Imaging the complications of bone marrow transplantation in children [J]. Radiographics, 2007; 27(2)∶307.
31. Kalantari BN, Mortelé KJ, Cantisani V, et al. CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults [J]. AJR Am J Roentgenol, 2003; 181(6)∶1621.
32. 宋彬, 徐隽，罗小华, 等. 螺旋CT 检查在诊断狼疮性缺血性肠病中的价值 [J]. 中国普外基础与临床杂志, 2004; 11（4）∶359.
33. Brody JM, Leighton DB, Murphy BL, et al. CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis [J]. Radiographics, 2000; 20(6)∶1525.
34. Guingrich JA, Kuhlman JE. Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications [J]. AJR Am J Roentgenol, 1999; 172(4)∶919.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Bowel Wall Thickening——CT Findings and Diagnostic Values

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